Disparities in Access to Pediatric Otolaryngology Care During the COVID-19 Pandemic

Objective: Racial/ethnic minority pediatric otolaryngology patients experience health disparities, including barriers to accessing health care. Our hypothesis for this study is that Hispanic or economically disadvantaged patients would represent a larger percentage of missed appointments and report more barriers to receiving care during the COVID-19 pandemic. Methods: A cross-sectional survey utilizing a modified version of the Barriers to Care Questionnaire was administered via telephone to no-show patients, and median income by zip code was collected. Chi-squared, logistic regression, and Student’s t-tests were used to investigate any differences in those who did and did not keep their appointments as well as any differences in mean questionnaire scores. Results: No-show patients were more likely to be Hispanic than not (OR 2.3, 95% CI: 1.3, 3.9, P = .002) and to live in a zip code that had a median income less than 200% of the federal poverty level (OR 1.7, 95% CI: 1.2, 2.4, P = .004). Respondents with a high school degree tended to report more barriers to care compared to those with less education. Conclusion: In our study, we identified ethnic, financial, and logistic concerns that may contribute to patients failing to keep their appointments with the otolaryngology clinic. Future studies are needed to assess the efficacy of measures aimed to reduce these barriers to care such as preventive plans to assist new patients and expanding telehealth services.

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Improving Attendance and Patient Experiences During the Expansion of a Telehealth-Based Pediatric Otolaryngology Practice

Otolaryngology ◽

10.1177/0194599820965917 ◽

2020 ◽

pp. 019459982096591

Author(s):

Caroline M. Kolb ◽

Kristen Born ◽

Karen Banker ◽

Patrick C. Barth ◽

Nicole Leigh Aaronson

Keyword(s):

Large Scale ◽

Administrative Support ◽

Tertiary Care ◽

Missed Appointments ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Pediatric Otolaryngology ◽

Common Causes ◽

Technical Issues ◽

English Speaking

Objective To determine the rates and primary causes of missed appointments (MAs) for telehealth visits and present remedies for improvement. Methods This cross-sectional survey was conducted at a tertiary care pediatric otolaryngology practice during expansion of telehealth-based visits. A review of questionnaire responses was performed for 103 consecutive patients with MAs over 50 business days from March 20, 2020, to May 29, 2020. Families were asked a brief survey regarding the cause of the MA and assisted with technical support and rescheduling. MA rates and causes were analyzed. Results The overall MA rate during the initiation of telehealth services was significantly increased at 12.4% as compared with clinic-based visits of a similar duration before COVID of 5.2% ( P < .001). Technical issues were the most common causes of MAs (51.3%). Of the caregivers, 23.8% forgot or reported cancellation of the appointment. Five percent of patients were non–English speaking and scheduled without translator support. Minorities and patients with public insurance represented 53.6% and 61.9% of MAs, respectively. Discussion Technical difficulties were the most commonly reported cause of missed telehealth appointments. Optimization of applications by providing patient reminders, determining need for translator assistance, and reducing required upload/download speeds may significantly reduce rates of MAs and conversions to other communication. Implications for Practice Clear, concise education materials on the technical aspects of telehealth, platform optimization, and robust technical and administrative support may be necessary to reduced missed telehealth appointments and support large-scale telehealth operations. An assessment of institutional capacity is critical when considering telehealth expansion.

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Barriers to care in patients with diabetes and poor glycemic control—A cross-sectional survey

PLoS ONE ◽

10.1371/journal.pone.0176135 ◽

2017 ◽

Vol 12 (5) ◽

pp. e0176135 ◽

Cited By ~ 21

Author(s):

Kerry A. McBrien ◽

Christopher Naugler ◽

Noah Ivers ◽

Robert G. Weaver ◽

David Campbell ◽

...

Keyword(s):

Glycemic Control ◽

Barriers To Care ◽

Poor Glycemic Control ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patients With Diabetes

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Usage of a Digital Health Workplace Intervention Based on Socioeconomic Environment and Race: Retrospective Secondary Cross-Sectional Study (Preprint)

10.2196/preprints.8819 ◽

2017 ◽

Author(s):

Conor Senecal ◽

R Jay Widmer ◽

Kent Bailey ◽

Lilach O Lerman ◽

Amir Lerman

Keyword(s):

Socioeconomic Status ◽

High Risk ◽

Digital Health ◽

Demographic Data ◽

Health Intervention ◽

Median Income ◽

Cross Sectional ◽

Socioeconomic Environment ◽

One Year ◽

Zip Code

BACKGROUND Digital health tools have been associated with improvement of cardiovascular disease (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes is not well known. OBJECTIVE To identify the effect of socioeconomic environment on usage of a digital health intervention. METHODS A retrospective secondary cross-sectional analysis of a workplace digital health tool use, in association with a change in intermediate markers of CVD, was undertaken over the course of one year in 26,188 participants in a work health program across 81 organizations in 42 American states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and hemoglobin A1c. Follow-up data was then obtained in 90-day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. Digital health intervention usage was analyzed based on socioeconomic status as well as age, gender, and race. RESULTS The cohort was found to represent a wide sample of socioeconomic environments from a median income of US $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Black participants showed a 40.5% increase and Hispanic participants showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasian participants. CONCLUSIONS The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and digital health intervention usage for Caucasian users. However, a strong relationship is present for black and Hispanic users. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for CVD. This finding identifies a need for digital health apps that are effective in these high-risk groups.

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Perception and misinformation during the COVID-19 pandemic: A cross sectional survey of deaf and hard of hearing adults in U.S. (Preprint)

10.2196/preprints.21103 ◽

2020 ◽

Author(s):

Raylene Paludneviciene ◽

Tracy Knight ◽

Gideon Firl ◽

Kaela Luttrell ◽

Kota Takayama ◽

...

Keyword(s):

Hard Of Hearing ◽

Online Survey ◽

Cross Sectional Study ◽

Asymptomatic Individual ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Public Health Agencies ◽

High School Degree ◽

Study Results ◽

Other Information

BACKGROUND During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the coronavirus on the Internet. If the language used in the video message is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, they can create confusion and information gaps among DHH people during a health emergency. OBJECTIVE To gather a baseline of DHH people’s perceptions related to effectiveness of physical distancing (PD) and asymptomatic individuals. METHODS A cross-sectional study of COVID-19 (N=445). Items included questions pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020 via a bilingual ASL/English online survey platform. RESULTS The sample consisted of 445 DHH adults aged 18 to 88 years old, with 74% identifying as White and 54% as female. About 88% of the sample felt they knew most or a lot about PD. This figure dropped to 73% for the effectiveness of PD in reducing the spread of coronavirus and 72% for the contagiousness of an infected person without symptoms. PD awareness along with education were significant predictors of PD effectiveness (adj OR for PD awareness=5.00; 95% CI: 2.09, 11.95; adj OR for education=1.89; 95% CI: 1.13, 3.16). In a separate model, education and PD effectiveness significantly predicted knowledge of asymptomatic individual. Race, gender, and age did not contribute to both models for PD effectiveness and knowledge of asymptomatic individual. CONCLUSIONS This study results point to the strong connection between education and coronavirus-related knowledge. Therefore, the information that DHH organizations and public health agencies quickly disseminate information during emergencies and pandemics must be clear, contain adequate and reliable information, and are timely in concordance with other information being disseminated.

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Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

BMC Health Services Research ◽

10.1186/s12913-020-05843-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Service Utilization ◽

Concentration Index ◽

Equal Treatment ◽

Dynamic Monitoring ◽

Inpatient Service ◽

Sampling Frame ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High School Degree ◽

Internal Migrants

Abstract Background Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. Methods The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level. Results Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively. Conclusion This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

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Impact of income in stage IV prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.244 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 244-244

Author(s):

Aabra Ahmed ◽

Timothy Dean Malouff ◽

Ryan W Walters ◽

Sydney Marsh ◽

Peter T. Silberstein

Keyword(s):

Prostate Cancer ◽

Median Survival ◽

Statistical Significance ◽

Stage Iv ◽

Median Income ◽

High School Degree ◽

Kaplan Meier ◽

Survival Differences ◽

The Impact ◽

Zip Code

244 Background: There is growing evidence of the impact of socioeconomic status on survival in cancer patients. To our knowledge, this is the largest study to examine demographics and the association between income and survival in patients with stage IV prostate cancer. Methods: Using the National Cancer Database, 50,639 patients diagnosed with stage IV prostate cancer between 2004-2011 were identified. Income was evaluated using the median income of the patient’s zip code. Between-income survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Survival differences were indicated between all income quartiles. Median survival was highest for patients in zip codes with a median income ≥ $63,000 and lowest for patients in zip codes with an income < $38,000 (46.1 months vs. 31.6 months, respectively; p < .001). As such, 41% of patients in zip codes with a median income ≥ $63,000 were alive five years following diagnosis, compared to 31% of patients in zip codes with median income < $38,000. Additionally, compared to patients in zip codes in which the median income was < $38,000, patients in zip codes with a median income ≥ $63,000 had a higher rate of zero comorbidities (81% vs. 76%), a greater percentage of patients living in an area where >93% people have a high school degree (58% vs 1%), and a lower proportion of African Americans (8% vs 41%). Conclusions: Compared to patients with a median income < $38,000, patients in zip codes with a median income > $63,000 had a median survival nearly 15 months longer, had 10% more patients alive after 5 years, and had fewer comorbidities. [Table: see text]

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The Association Between Veteran Status and Obesity Differs Across Race/Ethnicity

American Journal of Health Promotion ◽

10.1177/08901171211052994 ◽

2021 ◽

pp. 089011712110529

Author(s):

Adolfo G. Cuevas ◽

Leslie E. Cofie ◽

Sarah Nolte

Keyword(s):

Poverty Level ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Obesity Status ◽

Veteran Status ◽

Interview Survey ◽

Reported Health ◽

Race Ethnicity ◽

Self Reported Health Status ◽

Adjusted Model

Purpose This study aims to evaluate the interaction between veteran status and race/ethnicity on obesity status. Design Cross-sectional survey Setting The 2013–2017 National Health Interview Survey Sample A total of 151,765 adults (8.62% veterans and 91.38 nonveterans) with 69.30% identifying as White, 13.05% identifying as Hispanic, 12.57% identifying as Black, and 5.08% identifying as Asian Measures Obesity status (measured using self-reported body mass index), race/ethnicity, survey year, age, marital status, educational attainment, federal poverty level, health insurance, type of insurance, self-reported health status, and whether participant had a usual care source. Analysis Weighted logistic regression analysis Results In a fully adjusted model, there was no evidence that veterans overall had higher odds of obesity compared to nonveterans (adjusted odd ratio (aOR): 1.05, 95% CI: .99, 1.11). White veterans had lower odds of obesity compared to White nonveterans (OR: .93, 95% CI: .87, .98). Hispanic veterans had higher odds of obesity compared to Hispanic nonveterans (aOR: 1.53, 95% CI: 1.23, 1.90). There was no evidence of an association between veteran status and obesity status for Black and Asian adults. Conclusions Effectual prevention strategies are needed to decrease obesity risks among active and retired Hispanic veterans.

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Sociodemographic profile, clinical characteristics, anxiety, and depression of 74 patients infected with COVID-19: first report from Bangladesh

10.21203/rs.3.rs-32517/v1 ◽

2020 ◽

Author(s):

Mohammad Jahid Hasan ◽

Md. Abdullah Saeed Khan ◽

Monjur Rahman ◽

Md. Shahnoor Islam ◽

Sourav Debnath ◽

...

Keyword(s):

Clinical Characteristics ◽

Virus Disease ◽

Anxiety And Depression ◽

Median Income ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Male Predominance ◽

Runny Nose ◽

Sociodemographic Profile ◽

Ethical Clearance

Abstract Background: The pandemic of Corona Virus Disease 2019 (COVID-19) has cost a large number of lives and is causing substantial mental stress among people. We conducted a study to identify the sociodemographic and clinical characteristics and prevalence of anxiety and depression among confirmed COVID-19 cases in Bangladesh.Methods: An online cross-sectional survey using a preformed questionnaire adapted in Google form was conducted for data collection. The form was shared along with a brief introduction and rationale via Facebook, Twitter, Facebook Messenger, Viber, and What’s App. Formal ethical clearance was taken from the Biomedical Research Foundation, Bangladesh. Informed consent was ensured before participation.Results: Seventy-four patients with COVID-19 who had an average age of 42.59±14.43 years with male predominance (77%) were included. A total of 29.7% were doing health-care related jobs, and 14.9% lost their jobs due to COVID-19. Patients had a median income of BDT 30000. Of all, 87.8% of patients were symptomatic and presented with fever (77%), cough (58.8%), breathlessness (24.3%), myalgia (24.3%), sore throat (21.6%), fatigue (17.6%), nausea and/or vomiting (12.2%), headache (12.2%), runny nose (9.5%), chest pain (9.5%), diarrhea (8.1%), ARDS (2.7%), stuffy nose (2.7%), conjunctivitis (1.4%) and oral ulcer (1.4%). Overall, the prevalence of anxiety and depression was 60% and 52.9%, respectively. Among the participants, 11.4% had only anxiety, 4.3% had only depression and 48.6% had both.Conclusion: Patients were mostly middle aged, male and healthy workers. Typical presentations were fever and cough. Nearly two-thirds of the patients had either or both anxiety and depression.

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Diagnosis and management of surgical disease at Ethiopian health centres: cross-sectional survey of resources and barriers to care

BMJ Open ◽

10.1136/bmjopen-2019-031525 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031525

Author(s):

Nichole Starr ◽

Sarah Carpenter ◽

Melissa Carvalho ◽

Aileen Souza ◽

Robin Chin ◽

...

Keyword(s):

Barriers To Care ◽

Surgical Care ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Material Resources ◽

Patient Reported ◽

Health Centres ◽

Family Perceptions ◽

Specific Barriers

ObjectivesThe aim of this study was to characterise the resources and challenges for surgical care and referrals at health centres (HCs) in South Wollo Zone, Ethiopia.SettingEight primary HCs in South Wollo Zone, Ethiopia.ParticipantsEight health officers and nurses staffing eight HCs completed a survey.DesignThe study was a survey-based, cross-sectional assessment of HCs in South Wollo Zone, Ethiopia and data were collected over a 30-day period from November 2014 to January 2015.Primary and secondary outcome measuresSurvey assessed human and material resources, diagnostic capabilities and challenges and patient-reported barriers to care.ResultsEight HCs had an average of 18 providers each, the majority of which were nurses (62.2%) and health officers (20.7%). HCs had intermittent availability of clean water, nasogastric tubes, rectal tubes and suturing materials, none of them had any form of imaging. A total of 168 surgical patients were seen at the 8 HCs; 58% were referred for surgery. Most common diagnoses were trauma/burns (42%) and need for caesarean section (9%). Of those who did not receive surgery, 32 patients reported specific barriers to obtaining care (91.4%). The most common specific barriers were patients not being decision makers to have surgery, lack of family/social support and inability to afford hospital fees.ConclusionsHCs in South Wollo Zone, Ethiopia are well-staffed with nurses and health officers, however they face a number of diagnostic and treatment challenges due to lack of material resources. Many patients requiring surgery receive initial diagnosis and care at HCs; sociocultural and financial factors commonly prohibit these patients from receiving surgery. Further study is needed to determine how such delays may impact patient outcomes. Improving material resources at HCs and exploring community and family perceptions of surgery may enable more streamlined access to surgical care and prevent delays.

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Does universal health coverage reduce out-of-pocket expenditures for medical consultations for people living with HIV in Senegal? An exploratory cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-046579 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046579

Author(s):

Bernard Taverne ◽

Gabrièle Laborde-Balen ◽

Khaly Diaw ◽

Madjiguene Gueye ◽

Ndeye-Ngone Have ◽

...

Keyword(s):

National Health ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Health Coverage ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sex With Men ◽

Student’S T ◽

Living With Hiv ◽

The Impact

ObjectivesIn Senegal, a national health coverage system named Couverture Medicale Universelle (CMU) has been under development since 2013; its impact on out-of-pocket (OOP) expenses for people living with HIV (PLHIV) remains unknown. Our objective was to assess the impact of the national health coverage system on health expenses for PLHIV by measuring the OOP amount for a routine consultation for various categories of PLHIV, in Dakar and different regions in Senegal, viewed from the patients’ perspective.Design, setting and participantsCross-sectional survey in 2018 and 2019 using a face-to-face questionnaire with PLHIV: 344 adults followed up at Fann Regional Centre for research and training in clinical treatment in Dakar; 60 adult men who have sex with men (MSM) in 2 hospitals in Dakar and 7 facilities in the regions; and 130 children and adolescents (0–19 years) in 16 care facilities in the southern regions. We have calculated the total price of the consultation and associated prescriptions along with the patient’s OOP medical and transportation contributions. The average amounts were compared using the Student’s t-test.ResultsAll patients are on antiretroviral treatment with a median duration of 6 years, 5 years and 3 years for adults, MSM and children/adolescents, respectively. The percentage of people who have health coverage is 26%, 18% and 44% for adults, MSM and children. In practice, these systems are rarely used. The OOP amount (health expenses+transportation costs) for a routine consultation is €11 for adults and children, and €32.5 for MSM.ConclusionThe number of PLHIV with coverage is low, and the system’s effectiveness remains limited. Currently, this system has proved ineffective in implementing free healthcare, recommended by WHO since 2005.

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